10- to 20-year followup of total knee arthroplasty for valgus deformities

One hundred eight knees in 83 patients with a valgus alignment of greater than 10 degrees underwent total joint replacement performed by a single surgeon using the same technique for ligament balancing, which involved releasing the lateral retinaculum and iliotibial band, followed when necessary by detaching the lateral collateral ligament and popliteus tendon from the femur. Sixty knees in 46 patients had followup of at least 10 years and were the focus of study. At an average followup of 14.1 years, the mean Knee Society knee score was 88.7 and the mean functional score was 69.2. Postoperative knee alignment averaged 4.5 degrees with 75% of the knees corrected to between 2 degrees and 7 degrees valgus. Postoperative flexion averaged 101 degrees. There were no cases of peroneal nerve palsy or patellar dislocation. Six knees underwent revision surgery with two for sepsis, three for aseptic loosening, and one for a traumatic patella fracture. Radiographic component loosening also was seen in one knee. The probability of retention of the prosthesis was 91% (+/- 11.7%) at 13.2 years. Although the results in this group of patients seem acceptable, the rate of postoperative instability for all patients treated using this ligament balancing technique was 24%. Because of the high rate of instability, a new soft tissue release technique has been developed and is the preferred method for ligament balancing of the valgus knee during total knee arthroplasty.